MEDICARE: PINE STREET FAMILY PRACTICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1437103033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINE STREET FAMILY PRACTICE

Provider Business Mailing Address
First Line	:	220 PINE ST
Second Line	:
City	:	WILLIAMSTOWN
State	:	NJ
Zip	:	08094-1137
Country	:	US
Telephone Number	:	856-629-7436
Fax Number	:	856-875-4742

Provider Business Practice Location Address
First Line	:	220 PINE ST
Second Line	:
City	:	WILLIAMSTOWN
State	:	NJ
Zip	:	08094-1137
Country	:	US
Telephone Number	:	856-629-7436
Fax Number	:	856-875-4742

Authorized Official
Title or Position	:	PHYSICIAN/PRESIDENT
Name	:	DR. LEE ANN VAN HOUTEN-SAUTER
Credential	:	D.O.
Telephone Number	:	856-629-7436

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	08/22/2020

Similar Medicare Providers

1508869553 — LEE ANN VAN HOUTEN-SAUTER D.O.
Practice Location Address:

220 PINE ST
WILLIAMSTOWN, NJ
08094-1137

Practice Phone: 856-629-7436
Practice Fax: 856-875-4742

1285637223 — STEVEN MICHAEL LOWRY D.O.
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1780687723 — MEGAN EILEEN HARGRAVE D.O.
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Practice Fax: 856-875-4742

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1437098357 — EMPOWERED CARE SERVICES
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Directions to “PINE STREET FAMILY PRACTICE ” Practice Location

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